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PLICATION -- LOT L 44E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ! i <br /> AUTHORIZATION=SIG NATURES <br /> 3, <br /> ONLY THE OWNER OF THE PROPERTYORAN.AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project- <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: EVELIE M. GREBIL Signature: Date: � <br /> Print Name: MARY ANN SIMAS -•�� //^^ <br /> Signature: � C..� V ! Date: <br /> Print Name: ROSEMARIE TERRA BACCHETTI Signature:; 2 1CC Date: _L1 <br /> (FORMERLY KNOWN AS ROSEMARIE PETERS) <br /> Print Name: LORAINE TERRA Signature: r Date:_�(�l /6 <br /> Print Name: LINDA TERRA DODGE Signature: f Date: Q <br /> Print Name: JOE TERRA Signature: Date.- 1011'5103� _ <br /> Print Name: EILEEN TERRA STENT ignatur - G'�.._... Date:�bK <br /> I <br /> 'i <br /> 9 <br /> ;I <br /> .I <br /> F.OEVSVC\PlannftApplication Forms\ Page 3 of 3 Job No 2009-100 LLA <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />